Do Community Health Workers Need Formal Training and Certification?

RWJF grantee presents his research at the American Public Health Association annual meeting.

In New Mexico, community health workers have been a significant force in expanding access to health care for decades. Thirty-two of the state’s 33 counties are considered medically underserved, and the challenge of providing high quality care is compounded by widespread poverty and the vast diversity of the state’s population.

“Community health workers provide the cultural and community knowledge that nurses and other health professionals may not have, unless they’ve been working in that area for years,” says Mark Siemon, RN, APHN-BC, MPH, CPH, a fellow with the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico (UNM). Having worked closely with community health workers as a public health nurse with Indian Health Services in Arizona and New Mexico, Siemon says, “I’ve seen the value they bring.”

Though there is general consensus about the contributions of community health workers, there is no consensus about how they should be trained. Only a handful of states have standardized training or certification programs for community health workers. In 2008, New Mexico’s Department of Health established the Office of Community Health Workers to create a standardized—but voluntary—program.

Perceptions of Training

To learn more about how community health workers and their voluntary training program were being received in New Mexico, Siemon and his mentor, Cindy Mendelson, PhD, RN, an associate professor at UNM, conducted interviews with health care and social service professionals across the state. The results of their study were presented at the 2012 annual meeting of the American Public Health Association (APHA), which took place October 27-30 in San Francisco, Calif.

“Not surprisingly, we found everybody who had worked with community health workers really valued the work they did,” says Siemon. They saw how community health workers were able to connect with community members when other providers either didn’t have the time or the skills—culturally or linguistically—to reach them.

“I think the [community health worker] programs we’ve [implemented] have been phenomenal and successful,” a clinic administrator said in responding to the survey. They “have greatly added to the ability of providers to improve health outcomes for patients.”

Most survey respondents agreed there should be greater standardization of training for community health workers, but expressed real uncertainty about the best way to approach training and credentialing. Some said they have concerns about implementing uniform training for workers with very different jobs or tasks, and about losing years of experience if a community health worker who provides valuable services does not succeed in training or qualify to be credentialed.

Others voiced support for minimum criteria.

“Overall the feeling was that people were supportive of standardization of training as long as it didn’t change what the community health workers could do,” Siemon says.

Increasing Utilization

Community health workers are an ideal fit for states like New Mexico, Siemon says, but little is known about how to expand their services so they reach more communities in need.

“How do you get that level of trust where more health care providers want to utilize their skills in the health care system?” Siemon says. “We usually base that trust on a certificate, licensure or credentials, but we found mixed perception about whether or not that would actually expand the use of community health workers within primary health care teams.”

The health care professionals who were interviewed cited other barriers to increased use of community health workers in the state: namely, the lack of reimbursement for their services, and resistance from health care professionals who may feel threatened by task shifting or by an increased role for community health workers.

“If we really want to promote this model, it’s going to take more than certification and training,” Siemon says. “We need funding, and some consensus from health care organizations to use community health workers to meet the needs of the community and not just the needs of the organization. We need to break down the resistance to change.”

Siemon’s dissertation, underway at the Nursing and Health Policy Collaborative, will further examine health professionals’ perceptions of community health workers. He’s looking at the differences in perceptions of team climate among registered nurses who work with state certified community health workers, versus those who work with non-state certified community health workers.

The survey by Siemon and Mendelson is being submitted for publication.